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Adherence Issues (March 26)
Apr 13, 2004

A patient on Viread, Epivir, and Viramune was concerned about adherence with twice a day dosing. I understand that recent studies indicate that Viramune can be taken once a day. My doctor has patients on Viramune once a day. So, if his doctor agrees, he would not have to switch to Sustiva. He could take all of his meds once a day. Do you think that would be a possibility?

Response from Dr. Sherer

Yes, this is a possibility for this patient.

You are right that once daily nevirapine (or NVP or Viramune) was not significantly different than either twice daily NVP or efavirenz-containing regimens in the 2NN study by the percent of patients who had good virologic responses.

However, there were differences between once and twice daily NVP that your friend may want to consider. The incidence of hepatitis in patients on NVP was twice has high for once daily NVP, i.e. 12%, than for twice daily NVP, 6%, after 48 weeks of therapy.

These data occured in patients who were drug naive when started on NVP, so they may not apply to your friend, as you didn't mention how long he has been taking twice daily NVP, or what other regimens he has received, if any. Although hepatitis can occur at any time in patients on NVP, the highest incidence is in the first year of treatment.

It is interesting that this issue arises because your friend is concerned about adherence to a twice daily regimen, and is seeking a once daily regimen. There is no good evidence that once daily regimens are a solution to this problem, though anecdotally many patients say that once daily fits their lifestyle more easily, and hence they are less likely to miss doses.

As usual, my final recommendation is that your friend take this issue and these questions to his doctor for discussion and the next steps.

Also, as this is a public site with the explicit purpose of providing a means of dialogue with a clinician (for all the world to see), I am happy to answer your question. However, it is not my custom to answer patient-related questions about one patient to a third party without the patient's explicit consent. I will usually ask the questioner in such a setting whether it would be more appropriate for the patient to ask the question him or herself. Friends of people with HIV can be enormously helpful at providing support and helping with optimal medication adherence. However, there is a risk in unsolicited medical advice, both for the patient and the 'advisor', however well-intentioned.


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